Increasing life expectancy should be celebrated, but with it comes the challenges of the increased likelihood of multiple health conditions.
The knowledge required to understand the interdependency of the biological, social and psychological needs of older people is wide and diverse.
The Health Service Ombudsman’s report about the care of older people shows the complexities involved in their care, the distress that can result from poor care, and the many emotions which are embedded in such clinical episodes.
Nurses have a vital role to play in older people’s care. We are at the front of the service - we see, we hear, we do. But are we prepared, are we supported and are there enough of us to cope with these challenges?
Last year the RCN identified that in NHS wards for older people just 48% of staff were registered nurses, and that frequently ratios were one RN to every 11 patients. Research shows that staffing levels are unlikely to improve. In a recent survey of the British Geriatric Society consultant nurses for older people members found that 52% of respondents felt their role was only secure for the next 12 months, three were the only non-medical specialist in their area, and 11% had been approached about redundancy.
Care of older people demands not only the right staffing levels, but also specialist skills and expertise. Addressing hygiene, nutrition and toileting needs – which are so important for making us feel cared for – is not straightforward when a person has arthritis, osteoporosis, sensory issues and/or dementia.
Place yourself in a ward with 24 people frail and ill. There are three other staff. Six people have dementia and three are post-fracture hip repair. Each patient needs two people to help them to stand to go to the toilet. It is supper time and the drug round has started. A patient is nearing the end of their life and their relatives have had a 400 mile journey to see them. Another person has just returned from theatre.
There are so many priorities for nurses working on these wards. They need to respond to the relative’s questions and fears, offering emotional and practical support. They will need to pair up with colleagues to ensure the people needing the toilet are able to do so, in a supported and unrushed manner. They must undertake the medication round, understanding that medications are time specific and needed to ensure the person is not left in pain. They will also need to spend 20 minutes or more on each of the three individuals who need support to eat and drink to make it an enjoyable experience, and they will need to receive the patient from theatre, ensuring their comfort and safety. Good care is about nurses doing all of these things.
There is much that can be done to improve provision for older people but it starts by accepting it is not basic or simple. The skills and knowledge of the nursing workforce needs to reflect the patient population.
But what is vital is for commissioners to recognise that a must in caring for older people is about having time, to listen, to share, to give. And that can only be provided by having enough of the right staff.
Soline Jerram is a consultant nurse, older people and intermediate care, Berkshire East Community Health Services, and chair of the British Geriatric Society Consultant Nurse Special Interest Group